ALL BOLD PRINT MUST BE FILLED IN
SPONSORS CAN BE ADDED AT A LATER DATE
CAR # ASSIGNMENTS ARE ON A FIRST RECEIVED BASIS
BE SURE TO CHECK THE TRACK THAT YOU ARE REGISTERING FOR
RESERVED PARKING WILL NOT BE ACCEPTED WITHOUT TRACK REGISTRATION
2008 TRACK LICENSE & REGISTRATION
FAIRMONT RACEWAY ~ ALGONA RACEWAY ~ I-35 SPEEDWAY
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(PER TRACK)
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NAME____________________________ CLASS______________ CAR #__________
ADDRESS_______________________________ SOCIAL SECURITY #_______________________
CITY_______________________________ STATE_________________ ZIP____________
DATE OF BIRTH_____________________
HOME PHONE________________ WORK PHONE_______________e-mail_____________________
SPOUSES NAME___________________ JACKET SIZE__________
CAR OWNER________________________________
1099 to
driver? _____ If not–payee________________PAYEE
SOCIAL SECURITY
#________________
PAYEE
ADDRESS______________________ CITY___________ STATE_______ZIP_____________
SPONSORS______________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
AGREEMENT
CONTRACT:
I hereby certify that I am an
independent contractor. Assuming all responsibility for money received as a
result of my activities at the Raceway,
including without eliminating, income
taxes, FICA, workman’s compensation. I am not an employee, servant or agent of
the Raceway.
CONSIDERATION & COMPLIANCE:
In consideration of acceptance by the
Raceway of this application and payment of registration & license fees the
undersigned agrees to abide by all the rules and regulation of the Raceway as to
conduct and mechanical applications as now published or hereafter modified.
The
undersigned further recognizes his obligation to the public and to the Raceway,
which posts the prize monies and conducts the events and agrees to
compete in
all events for which he may be qualified if humanly possible.
BREACH & DAMAGE:
In the event the undersigned breaches this agreement, he shall be liable for
actual and liquidated damages sustained by the Raceway
as a direct or indirect
result of such breach.
BENEFITS:
I understand and agree that myself and my
executors and assigns will be entitled to the benefits of the Competitor
Accident Insurance Policy
procured by the Raceway for accidental death or
injuries which occur as the result of external, violent and visible means
sustained in Raceway events.
The coverage of said policy shall constitute the
limit of liability of the Raceway for such injuries occurring to me an any
Raceway event, provided proper
notification of such occurrence is filed with the
Raceway.
ADVERTISING RELEASE:
The undersigned consents to the use of his name and/or pictures of himself and
his car for publicity, advertising and endorsements,
both before and after
events, and relinquished any rights to photos taken in connection with events,
and consents to the publication or sale of such photos by the Raceway.
This
includes any video or delayed transmission of images.
ARBITRATION:
Any dispute, controversy or claim involving the
undersigned, whether or not relating to this agreement of same, shall be settled
in accordance with
existing and/or amended rules and regulation of the Raceway,
and the undersigned agrees to accept the decision rendered by such process.
BY MY SIGNATURE
BELOW, I CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THIS AGREEMENT.
I AGREE TO ABIDE BY ALL TERMS OF THIS AGREEMENT AND THE RULES OF
THE RACEWAY.
SIGNATURE_______________________________ DATE_______________
PARENT/GUARDIAN OF MINOR__________________________________